Esophagus to Small Intestine
Inflamm Bowel Dis. 2023;29(3):417−22
Long-term outcomes of the excluded rectum in Crohn’s disease: A multicenter international study
Background: Many patients with Crohn’s disease (CD) require fecal diversion. To understand the long-term outcomes, a multicenter review of the experience with retained excluded rectums was performed.
Methods: The authors reviewed the medical records of all CD patients between 1990 and 2014 who had undergone diversionary surgery with retention of the excluded rectum for at least 6 months and who had at least 2 years of postoperative follow-up.
Results: From all the CD patients in the institutions’ databases, there were 197 who met all inclusion criteria. A total of 92 of 197 patients (46.7%) ultimately underwent subsequent proctectomy, while 105 (53.3%) still had retained rectums at time of last follow-up. Among these 105 patients with retained rectums, 50 (47.6%) underwent reanastomosis, while the other 55 (52.4%) retained excluded rectums. Of these 55 patients whose rectums remained excluded, 20 (36.4%) were symptom-free, but the other 35 (63.6%) were symptomatic. Among the 50 patients who had been reconnected, 28 (56%) were symptom-free, while 22 (44%) were symptomatic. From the entire cohort of 197 cases, 149 (75.6%) either ulti-mately lost their rectums or remained symptomatic with retained rectums, while only 28 of 197 (14.2%), and only 4 of 66 (5.9%) with initial perianal disease, were able to achieve reanastomosis without further problems. Four patients developed anorectal dysplasia or cancer.
Conclusions: In this multicenter cohort of patients with Crohn’s disease who had fecal diversion, fewer than 15%, and only 6% with perianal disease, achieved reanastomosis without experiencing disease persistence.
DOI: 10.1093/ibd/izac099